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Streptomycin

Medically reviewed by Drugs.com. Last updated on July 9, 2020.

Pronunciation

(strep toe MYE sin)

Index Terms

  • Streptomycin Sulfate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intramuscular [preservative free]:

Generic: 1 g (1 ea)

Pharmacologic Category

  • Antibiotic, Aminoglycoside
  • Antitubercular Agent

Pharmacology

Inhibits bacterial protein synthesis by binding directly to the 30S ribosomal subunits causing faulty peptide sequence to form in the protein chain

Absorption

Oral: Poorly absorbed; IM: Well absorbed

Distribution

Distributes into most body tissues and fluids except the brain; small amounts enter the CSF only with inflamed meninges

Excretion

Urine (29% to 89% as unchanged drug); small amount (1%) excreted in bile, saliva, sweat, and tears

Time to Peak

IM: Within 1 to 2 hours

Half-Life Elimination

Newborns: 4 to 10 hours; Adults: ~2 to 4.7 hours; prolonged with renal impairment

Protein Binding

34%

Use: Labeled Indications

Tuberculosis:

Treatment of tuberculosis, in combination with other appropriate antituberculosis agents, when the primary agents are contraindicated because of toxicity or intolerance.

Nontuberculosis infections:

Treatment of infections caused by susceptible bacteria that are not amenable to therapy with less potentially toxic agents, including sensitive Yersinia pestis (plague); Francisella tularensis (tularemia); Brucella; Klebsiella granulomatis (donovanosis, granuloma inguinale); Haemophilus ducreyi (chancroid); Haemophilus influenzae (in respiratory, endocardial, and meningeal infections, concomitantly with another antibacterial agent); Klebsiella pneumoniae pneumonia (concomitantly with another antibacterial agent); Escherichia coli, Proteus spp., Klebsiella aerogenes (formerly Enterobacter aerogenes), K. pneumoniae, and Enterococcus faecalis in urinary tract infections; Streptococcus viridans; E. faecalis (in endocardial infections, concomitant with penicillin); and gram-negative bacillary bacteremia (concomitant with another antibacterial agent).

Off Label Uses

Mycobacterium avium complex infection

Based on an official statement on the diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases from the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) and the British Thoracic Society guidelines for the management of nontuberculous mycobacterial pulmonary disease, streptomycin for the first 2 to 3 months of therapy in combination with other antimicrobials is effective and recommended for the treatment of extensive M. avium complex (MAC) disease, especially fibrocavitary or severe nodular/bronchiectatic disease, patients who have failed prior drug therapy, or patients with clarithromycin-resistant MAC pulmonary disease [ATS/IDSA [Griffith 2007]], [BTS [Haworth 2017]].

Based on the US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of nontuberculosis mycobacteria in individuals with cystic fibrosis, streptomycin for the first 1 to 3 months of therapy in combination with other antimicrobials should be considered in patients with cystic fibrosis with acid-fast bacilli smear-positive respiratory samples, with radiological evidence of lung cavitation or severe pulmonary infection, or with systemic signs of illness [CFF/ECFS [Floto 2016]].

Based on the US Department of Health and Human Services guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV, streptomycin is an effective and recommended alternative agent in the management of disseminated MAC in patients with HIV.

Mycobacterium kansasii infection, rifampin resistant

Based on an official statement on the diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases from the ATS and the IDSA, streptomycin given for M. kansasii infection is effective and recommended in the management of this condition [ATS/IDSA [Griffith 2007]].

Contraindications

Hypersensitivity to streptomycin, other aminoglycosides, or any component of the formulation

Dosing: Adult

Note: Route of administration: Manufacturer’s labeling states for IM administration only; however, IV administration (off-label route) has been described (Morris 1994; Peloquin 1992; Tanoira 2014).

Aminoglycoside dosing weight: For underweight patients (ie, total body weight [TBW] < ideal body weight [IBW]), calculate the dose based on TBW. For nonobese patients (ie, TBW 1 to 1.25 × IBW), calculate the dose based on TBW or IBW. TBW may be preferred in nonobese patients who may have increased volume of distribution (eg, critically ill). For obese patients (ie, TBW > 1.25 × IBW), calculate the dose based on 40% adjusted body weight (IBW + [0.4 × (TBW-IBW)]) (Blackburn 2015; Drew 2020). Therapeutic drug monitoring: Monitoring of serum concentrations is recommended to ensure efficacy and avoid toxicity; confirm availability of rapid streptomycin serum concentrations. Timing and frequency of concentration monitoring is individualized based on dosing and monitoring strategy (AHA [Baddour 2015]; Drew 2020; Park 2015; Zhu 2001).

Usual dosage range: IM, IV: 15 to 30 mg/kg/day or 1 to 2 g daily.

Indication-specific dosing:

Brucellosis: IM, IV: 1 g once daily in combination with doxycycline. Duration depends on extent of disease; streptomycin is usually given for the first 14 to 21 days of therapy, followed by doxycycline monotherapy (Ariza 2007; Bosilkovski 2020; Hasanjani Roushan 2006; Skalsky 2008). Note: Additional agents or other regimens are preferred for neurobrucellosis, endocarditis, and infection in pregnant women (Bosilkovski 2020).

Endocarditis (alternate agent):

Enterococcus spp. (native or prosthetic valve, susceptible to penicillin and streptomycin/resistant to gentamicin): IM, IV: 7.5 mg/kg every 12 hours in combination with ampicillin or penicillin; Duration of therapy: 4 weeks (native valve and symptoms present <3 months); ≥6 weeks (native valve and symptoms present ≥3 months or prosthetic valve). Note: For native valve endocarditis due to ampicillin-susceptible E. faecalis, a combination regimen that does not contain streptomycin is preferred (AHA [Baddour 2015]).

Mycobacterial (nontuberculous) infection (off-label use):

Mycobacterium avium complex infection (off-label use):

Pulmonary disease, cavitary or severe bronchiectatic, clarithromycin-resistant, or refractory (adjunctive agent): IM, IV: 15 mg/kg once daily 5 times weekly or 25 mg/kg 3 times weekly (ATS/IDSA [Griffith 2007]; Peloquin 2004) or 10 to 15 mg/kg 3 times weekly (Kasperbauer 2020) or 15 mg/kg once daily (usual maximum dose: 1 g) for 1 month then 15 mg/kg 3 times weekly (BTS [Haworth 2017]). Give streptomycin as part of an appropriate combination regimen for the first 2 to 3 months of therapy (ATS/IDSA [Griffith 2007]). Note: For older adults or patients who require >6 months of parenteral therapy, empiric dose reduction is recommended (ATS/IDSA [Griffith 2007); BTS [Haworth 2017]).

Pulmonary disease (cavitary or severe bronchiectatic or acid-fast bacilli smear-positive respiratory samples) or systemic illness in patients with cystic fibrosis (adjunctive agent): IM, IV: 15 mg/kg once daily (maximum: 1 g daily) as part of an appropriate combination regimen (CFF/ECFS [Floto 2016]).

Disseminated disease in patients with HIV with CD4 count <50 cells/mm3, high mycobacterial loads (ie, >2 log colony-forming units/mL of blood), or in the absence of effective antiretroviral therapy (adjunctive agent): IM, IV: 1 g once daily as part of an appropriate combination regimen (HHS [OI adult 2019]).

M. kansasii infection, rifampin-resistant (adjunctive agent): IM: 750 mg to 1 g daily or 5 times weekly as part of an appropriate combination regimen (ATS/IDSA [Griffith 2007]; Campbell 2000).

Plague: IM: 15 mg/kg (maximum dose: 1 g) every 12 hours for 10 days or until the patient is afebrile for at least 2 to 3 days (CDC 2014; WHO 2009).

Tuberculosis (alternative agent): IM, IV: 15 mg/kg once daily or 25 mg/kg 3 times weekly (ATS/CDC/ERS/IDSA [Nahid 2019]; ATS/CDC/IDSA [Nahid 2016]).

Tularemia (alternative agent): IM: 1 g twice daily for ≥10 days depending on severity (CDC 2019; WHO 2007).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Geriatric

Dose reductions are recommended by the manufacturer in patients >60 years of age.

Mycobacterium avium complex disease: IM/IV: 8 to 10 mg/kg 2 to 3 times weekly (maximum dose for >50 years of age: 500 mg) (ATS/IDSA [Griffith 2007]) or 10 mg/kg once daily for the first month followed by 15 mg/kg 3 times weekly (maximum dose for >59 years of age: 750 mg) (BTS [Haworth 2017]).

Dosing: Pediatric

Note: IM route preferred; consider use of IV route if IM therapy not tolerated. Monitor serum drug concentrations.

General dosing, combination therapy for susceptible infection: Infants, Children, and Adolescents:

Manufacturer's labeling: IM: 20 to 40 mg/kg/day in divided doses every 6 to 12 hours; maximum dose: 1,000 mg/dose; maximum daily dose: 2,000 mg/day

Alternate dosing: IM, IV: 20 to 30 mg/kg/day divided every 12 hours; maximum daily dose: 1,000 mg/day (Bradley 2015)

Endocarditis, Enterococcal, resistant to gentamicin: Infants, Children, and Adolescents: IM, IV: 20 to 30 mg/kg/day divided every 12 hours; maximum daily dose: 2,000 mg/day; used in combination with other antibiotics, adjust dose to target concentrations (AHA [Baddour] 2005)

Mycobacterium avium complex, treatment: Limited data available: Adolescents: IM, IV: 1,000 mg once daily as part of combination therapy (HHS [Adult] 2016)

Mycobacterium ulcerans (Buruli ulcers): Limited data available: Infants, Children, and Adolescents: IM: 15 mg/kg once daily; maximum daily dose: 1,000 mg/day; used in combination with rifampin for 8 weeks, or may use this combination for 4 weeks, followed by 4 weeks of rifampin-claithromycin combination therapy (WHO 2012)

Plague: Infants, Children, and Adolescents: IM, IV: 30 mg/kg/day divided every 12 hours for 10 days; maximum daily dose: 2,000 mg/day (Red Book [AAP] 2015; WHO 2009)

Tuberculosis; active infection; treatment (second-line therapy); multidrug-resistant (MDR) or meningitis: Note: Always use as part of a multidrug regimen. Any regimens using less than once daily dosing should administer dosing as directly observed therapy (DOT). Treatment regimens for MDR TB are variable depending upon sensitivity and clinical response. Streptomycin frequency and dosing differs depending on treatment regimen selected; consult current drug-sensitive TB guidelines for detailed information (ATS/CDC/IDSA [Nahid 2016]; Schaaf 2015).

Primary pulmonary disease:

Once daily therapy:

Infants, Children, and Adolescents <15 years weighing ≤40 kg: Note: Suggested expert dosing range is large and variable (Schaaf 2015); IM, IV: 15 to 40 mg/kg/dose once daily; some experts recommend an initial dose range of 15 to 20 mg/kg/dose once daily; maximum daily dose: 1,000 mg/day; monitor serum concentrations (ATS/CDC/IDSA [Nahid 2016]; Schaaf 2015; WHO, 2009a). Note: Some clinicians suggest every 12-hour dosing may be utilized (Berenberg 1951; Bradley 2015).

Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years: IM, IV: 15 mg/kg/dose once daily; maximum daily dose: 1,000 mg/day; monitor serum concentrations (ATS/CDC/IDSA [Nahid 2016]; Pérez Tanoira 2014)

Three-times-weekly DOT: Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years: IM, IV: 25 mg/kg/dose three times weekly; maximum dose: 1,000 mg/dose (ATS/CDC/IDSA [Nahid 2016]

Twice weekly DOT: Infants, Children, and Adolescents <15 years weighing ≤40 kg: IM, IV: 25 to 30 mg/kg/dose twice weekly; maximum dose: 1,000 mg/dose (ATS/CDC/IDSA [Nahid 2016])

Meningitis (independent of HIV-status): Infants, Children, and Adolescents: Note: Suggested expert dosing range is large and variable (Schaaf 2015): IM, IV: 15 to 40 mg/kg/dose once daily; some experts recommend an initial dose range of 15 to 20 mg/kg/dose once daily; maximum daily dose: 1,000 mg/day; monitor serum concentrations (ATS/CDC/IDSA [Nahid 2016]; DHHS [pediatric] 2013; Red Book [AAP] 2015; Schaaf 2015)

Tularemia: Infants, Children, and Adolescents: IM: 15 mg/kg/dose twice daily for 10 days; maximum daily dose: 2,000 mg/day (WHO 2007)

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Reconstitution

IM: Reconstitute vial with 4.2 mL, 3.2 mL, or 1.8 mL sterile water for injection (SWFI) to yield a final concentration of ~ 200 mg/mL, ~250 mg/mL, or ~400 mg/mL, respectively

IV: Further dilute dose to concentration of 5 to 10 mg/mL in D5W or NS (Morris 1994; Peloquin 1992; Tanoira 2014)

Administration

IM: Inject deep IM into large muscle mass; midlateral thigh muscle or upper outer quadrant of buttocks; rotate injection sites.

IV (off-label route): After dilution in admixture, infuse over 30 to 60 minutes (Morris 1994; Peloquin 1992; Tanoira 2014)

Storage

Store intact vials at 20°C to 25°C (68°F to 77°F). Protect from light. Reconstituted solution may be stored at room temperature for up to 1 week.

Depending upon manufacturer, reconstituted solution remains stable for 24 hours at room temperature. Exposure to light causes darkening of solution without apparent loss of potency.

Drug Interactions

Amphotericin B: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Arbekacin: May enhance the nephrotoxic effect of Aminoglycosides. Arbekacin may enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Ataluren: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, an increased risk of nephrotoxicity may occur with the concomitant use of ataluren and aminoglycosides. Avoid combination

Bacitracin (Systemic): Streptomycin may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy

Bisphosphonate Derivatives: Aminoglycosides may enhance the hypocalcemic effect of Bisphosphonate Derivatives. Monitor therapy

Botulinum Toxin-Containing Products: Aminoglycosides may enhance the neuromuscular-blocking effect of Botulinum Toxin-Containing Products. Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Aminoglycosides. Monitor therapy

CARBOplatin: Aminoglycosides may enhance the ototoxic effect of CARBOplatin. Especially with higher doses of carboplatin. Monitor therapy

Cephalosporins: May enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Avoid combination

CISplatin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Colistimethate: Aminoglycosides may enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Management: Avoid coadministration of colistimethate and aminoglycosides whenever possible due to the risk of nephrotoxicity and neuromuscular blockade. If coadministration cannot be avoided, monitor renal and neuromuscular function. Consider therapy modification

CycloSPORINE (Systemic): Aminoglycosides may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Monitor therapy

Distigmine: Aminoglycosides may diminish the therapeutic effect of Distigmine. Monitor therapy

Foscarnet: May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy

Loop Diuretics: May enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy

Mannitol (Systemic): May enhance the nephrotoxic effect of Aminoglycosides. Avoid combination

Mecamylamine: Aminoglycosides may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination

Methoxyflurane: Aminoglycosides may enhance the nephrotoxic effect of Methoxyflurane. Avoid combination

Neuromuscular-Blocking Agents: Aminoglycosides may enhance the therapeutic effect of Neuromuscular-Blocking Agents. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May decrease the excretion of Aminoglycosides. Data only in premature infants. Monitor therapy

Oxatomide: May enhance the ototoxic effect of Aminoglycosides. Monitor therapy

Penicillins: May decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification

Tacrolimus (Systemic): Aminoglycosides may enhance the nephrotoxic effect of Tacrolimus (Systemic). Monitor therapy

Tenofovir Products: Aminoglycosides may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Aminoglycosides. Monitor therapy

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Consider therapy modification

Vancomycin: May enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Hypotension

Central nervous system: Drug fever, facial paresthesia, headache, neurotoxicity

Dermatologic: Exfoliative dermatitis, skin rash, urticaria

Gastrointestinal: Nausea, vomiting

Genitourinary: Azotemia, nephrotoxicity

Hematologic & oncologic: Eosinophilia, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia

Hypersensitivity: Anaphylaxis, angioedema

Neuromuscular & skeletal: Arthralgia, tremor, weakness

Ophthalmic: Amblyopia

Otic: Auditory ototoxicity, vestibular ototoxicity

Respiratory: Dyspnea

<1%, postmarketing, and/or case reports: DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), toxic epidermal necrolysis

ALERT: U.S. Boxed Warning

Toxicity:

The risk of severe neurotoxic reactions is sharply increased in patients with impaired renal function or prerenal azotemia. These include disturbances of vestibular and cochlear function, optic nerve dysfunction, peripheral neuritis, arachnoiditis, and encephalopathy. The incidence of clinically detectable, irreversible vestibular damage is particularly high in patients treated with streptomycin.

Renal function should be monitored carefully; patients with renal impairment and/or nitrogen retention should receive reduced doses. The peak serum concentration in individuals with kidney damage should not exceed 20 to 25 mcg/mL.

The concurrent or sequential use of other neurotoxic and/or nephrotoxic drugs with streptomycin, including neomycin, kanamycin, gentamicin, cephaloridine, paromomycin, viomycin, polymyxin B, colistin, tobramycin, and cyclosporine should be avoided.

The neurotoxicity of streptomycin can result in respiratory paralysis from neuromuscular blockage, especially when the drug is given soon after the use of anesthesia or muscle relaxants.

The administration of streptomycin in parenteral form should be reserved for patients where adequate laboratory and audiometric testing facilities are available during therapy.

Warnings/Precautions

Concerns related to adverse effects:

• Neuromuscular blockade and respiratory paralysis: [US Boxed Warning]: May cause neuromuscular blockade and respiratory paralysis; especially when given soon after anesthesia or muscle relaxants.

• Neurotoxicity: [US Boxed Warning]: May cause neurotoxicity, including disturbances of vestibular and cochlear function, optic nerve dysfunction, peripheral neuritis, arachnoiditis, and encephalopathy; usual risk factors include pre-existing renal impairment, concomitant neuro-/nephrotoxic medications. Ototoxicity is proportional to the amount of drug given and the duration of treatment. Tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage. Baseline and periodic caloric stimulation and audiometric tests are recommended with prolonged therapy. Discontinue treatment if signs of ototoxicity occur.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Hearing impairment: Use with caution in patients with pre-existing vertigo, tinnitus, or hearing loss.

• Neuromuscular disorders: Use with caution in patients with neuromuscular disorders, including myasthenia gravis.

• Renal impairment: [US Boxed Warning]: May cause nephrotoxicity. Use with caution in patients with renal impairment; dose adjustment necessary in patients with renal impairment and/or nitrogen retention. Monitor renal function closely; peak serum concentrations should not surpass 20 to 25 mcg/mL in patients with renal impairment.

Concurrent drug therapy issues:

• Neurotoxic and/or nephrotoxic drugs: [US Boxed Warning]: Avoid concomitant or sequential use with other neurotoxic and/or nephrotoxic drugs (eg, neomycin, kanamycin, gentamicin, paromomycin, polymyxin B, colistin, tobramycin, cyclosporine).

Dosage form specific issues:

• Sulfite sensitivity: Some formulations may contain sodium metabisulfite; may cause allergic reactions including anaphylaxis or asthma exacerbations (some life-threatening) in susceptible patients.

Other warnings/precautions:

• Appropriate use: [US Boxed Warning]: Parenteral form should be used only where appropriate audiometric and laboratory testing facilities are available. IM injections should be administered in a large muscle well within the body to avoid peripheral nerve damage and local skin reactions.

Monitoring Parameters

Baseline and periodic hearing tests (audiograms), clinical assessment for vertigo and tinnitus, BUN, creatinine, serum electrolytes; serum drug concentrations should be monitored in all patients (ATS/CDC/ERS/IDSA [Nahid 2019]).

Reproductive Considerations

Evaluate pregnancy status prior to treatment of multidrug resistant tuberculosis in females of reproductive potential. Females of reproductive potential should use effective contraception during treatment for multidrug resistant tuberculosis (Esmail 2018).

Pregnancy Risk Factor

D

Pregnancy Considerations

Streptomycin crosses the placenta.

Streptomycin may cause fetal harm if administered to a pregnant patient. There are multiple reports of total irreversible bilateral congenital deafness in children whose mothers received streptomycin during pregnancy.

Streptomycin is approved for the treatment of tuberculosis. Active tuberculosis infection is associated with adverse fetal outcomes including intrauterine growth restriction, low birth weight, preterm birth, and perinatal death (Esmail 2018; Miele 2020) as well as adverse maternal outcomes, including increased risks for anemia and cesarean delivery. Placental transmission may rarely occur with active maternal disease (Miele 2020). The treatment of multidrug resistant tuberculosis in pregnant patients should be individualized; evidence to support a specific regimen is not available (ATS/CDC/ERS/IDSA [Nahid 2019]; WHO 2020). When second-line agents are needed for the treatment of multidrug resistant tuberculosis during pregnancy, aminoglycosides should be avoided when alternative agents are effective (ATS/CDC/ERS/IDSA [Nahid 2019]). Streptomycin is not the preferred agent when an aminoglycoside is required for the treatment of tuberculosis during pregnancy (HHS [OI adult 2019]).

Streptomycin is approved for the treatment of Yersinia pestis (plague) infection. Untreated infection has a high rate of maternal death and fetal loss. When an aminoglycoside is needed for the treatment of Y. pestis during pregnancy, an agent other than streptomycin is preferred (Fleck-Derderian 2020; WHO 2009; Yu 2020).

Patient Education

What is this drug used for?

• It is used to treat TB (tuberculosis).

• It is used to treat bacterial infections.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Diarrhea

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Kidney problems like unable to pass urine, blood in urine, change in amount of urine passed, or weight gain

• Change in balance

• Confusion

• Nausea

• Vomiting

• Dizziness

• Passing out

• Headache

• Muscle weakness

• Hearing loss

• Twitching

• Seizures

• Trouble breathing

• Slow breathing

• Shallow breathing

• Vision changes

• Severe loss of strength and energy

• Burning or numbness feeling

• Noise or ringing in the ears

Clostridioides (formerly Clostridium) difficile-associated diarrhea like abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.